Friday, June 3, 2011

Covered Wagon MCI

Over the course of the last few weeks the Ambulance has been preparing to be a part of a local Mass Casualty Incident (MCI) drill.  In fact we were quite excited about this particular drill because we had recently completed MCI training with A. J. Heightman and were ready to practice what we learned.  The focus of the drill was the gas drilling industry that recently has taken our area by storm.  As with all our local drills it included county EMS, Fire, Rescue and the Hospital ER and their hospital based ALS staff.  In addition the Dept of Environmental Resources and regional representatives of gas drilling companies were also expected to assess their abilities during this drill.  The drill was scheduled June 2, 2011, at 1700.

At 1759 on June 2, 2011, dispatchers from the Communications Center began dispatching a rescue call.  During the initial parts of the dispatch everyone assumed that the drill had started late and expected to hear the common “this is a drill” appended to the end of the dispatch.  As we listened to the quiet and calm voice of the dispatcher we began to realize that the things we knew about the drill did not agree with the details in the dispatch.  Station 1 and 10, Medic 1 and 2, four helicopters, in the park for a tree fallen on a covered wagon, multiple injuries, with entrapment.  This is a senior travel group.

Response was nearly instantaneous with the EMS Chief and Assistant Fire Chief  first to contact the communications center.  Further information was relayed to them and they requested two additional BLS ambulances  which had already staged at the scene of the drill only a few miles from us, and BLS ambulances from two other stations the next closest BLS units to the scene.

We responded with our preplanned units for calls in the canyon with two ambulances, a four wheel drive squad, and heavy rescue.  These units were immediately followed up by a rescue engine, ambulance, and another engine to assist with the landing zone for the helicopters.  Station 10  also part of the preplan for rescue responses in the canyon responded simultaneously with equivalent units.
As all the units responded the 11 miles to the access area for the rails to trails hiking and nature area additional information was forwarded by the dispatchers.  Two horse drawn wagons were part of a tour with only one wagon suffering a direct hit by a large falling oak tree.   Callers estimated that more than 20 elderly people were on the covered wagon that was hit and several were severely injured and entrapped under the tree.  At that point helicopters from Western Pennsylvania were put on standby and additional ALS and BLS units were contacted in New York State to determine availability.  BLS units from within the county were also moved up to cover stations closer to the scene.

After gaining access to the trail the Asst. Chief arrived on scene first and set up Command.   The trail consists of an old double track Conrail mainline where the tracks have been removed and the railroad bed upgraded for hiking, biking, and horseback riding.  It is a much visited scenic area with gated access for motorized vehicles.  Another Assistant Chief was identified as staging officer and set up EMS and Rescue staging at the access parking area near the trail entrance.
Medic units proceeded to the wagon and set up initial triage about .75 miles from the access area.  EMS Chief  assumed EMS Branch with paramedics taking roles in both triage and augmenting BLS units with patient treatment.  Needed medical equipment was stripped from the first in ambulances and the SMART triage system was initiated.
Initial triage showed 10 total injuries and 10 other non-injured but stressed fellow riders.  Three of the injuries were triaged as immediate and 7 as delayed.   There were no patients trapped.

One ambulance each from three stations left for the landing zone with one immediate patient accompanied by ALS.  The landing zone was set up at the Airport approximately three miles from the scene.  It afforded the LZ officer the luxury of landing multiple helicopters in a safe easily accessed area with backup radio contact available via airport officials.  The helicopters all flew to the area’s closest trauma facility.
Seven other ambulances each transported one patient to the ER and returned to their respective stations.  After transporting a patient to the airport one ambulance continued on to the ER with the spouse who reported not feeling well.  A total of 11 patients were transported and 9 others sent to secondary triage prior to getting back on their bus.

Transparent to the patients there were a number of things that allowed this brief, less than three hour MCI to dovetail into a smooth effective operation.
 I had already mentioned that two months prior A. J. Heightman held his MCI class at our station allowing us a real opportunity to practice working an MCI and setting up a true EMS command structure.
·         Our Regional Medical Council provided SMART triage tags for our use on all ambulance calls during National EMS Week in May allowing all BLS staff a recent opportunity to practice with the tags, ALS staff to re-triage patients during that week, and ER staff to become familiar with the use of the tags.
·         The coincidence of having an MCI drill scheduled for virtually the same time and date allowed a quicker response for our units that were already manned and ready to report to the drill.
·         Due to the distance from populated areas our scene was easily secured and police and state park personnel had little or no trouble with on lookers.

What we learned.
·         You cannot overestimate the assistance that your communications center can provide.  They simultaneously dispatched on two frequencies, provided updates while we responded, set up medical channels, contacted medical helicopters, made an unknown number of important phone calls including state and local notifications, and generally used their collective expertise to stay one step ahead of our requests.
·         Stations that regularly respond as a cohesive group from opposite sides of the canyon to provide technical rescue and medical services to park visitors.  Knowing and having confidence in those coming to help you reduces some of the initial stress.
·         Scene control is important, even in the middle of nowhere.
·         It is much better to call for resources early than to need them when they still have an extended ETA.
·         And, that much of the work takes place after the incident is complete as ambulances are restocked, rescue and fire vehicles are again made whole, and the paperwork is completed.